What to say to the Boston Marathon survivors

Adrianne Haslet, a a professional ballroom dancer injured by one of the bombs that exploded near the Boston Marathon finish line, lifts her bandaged left leg in her bed at Spaulding Rehabilitation Hospital in Boston, Wednesday, April 24, 2013. Haslet, who lost her left foot and part of her lower leg, vows that she will dance again. (AP Photo/Bizuayehu Tesfaye)

President Barack Obama went to Boston to put his arms around the concentric circles of the injured, the families of the victims, the first responders, marathoners, Bostonians and Americans. In his role as consoler-in-chief he said:

"We will all be with you as you learn to stand and walk and, yes, run again. Of that I have no doubt. You will run again. You will run again."

The president's expression of solidarity is deeply moving. Yet his battle cry for resiliency and recovery caught our attention. Does it really help a young person who just lost his legs to hear this? How were his words received by the wider American audience of people with disabilities, including the thousands of injured veterans of the Iraq and Afghanistan wars and their families?

As Barbara Ehrenreich and others have written, American culture has a strong streak of not only optimism but "Pollyana-ism."

Consider the popularity of "The Secret," which suggests that positive thinking leads to health and good fortune. Positive psychology has influenced health research as well. Studies in rehabilitation psychology show that people who express more optimism and hope early in their recovery, work harder in physical therapy during the immediate six months post injury.

However, coping in the short run and long-run adaptation are not the same thing. Outside the glare of the hospital lights, past the six-month sojourn in the supportive world of a rehabilitation facility, people come home alone to able-bodied families and communities.

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Often, they feel terrible isolation, difference and despair about what they've lost. What do we say when the people we care for are not feeling so hopeful?

Interviews with people several years after a significant health loss suggest that ongoing pressure to put on a good face for their loved ones, their community and the public results in feeling isolated and numb.

It is only when stoic coping hits a bump and the disabled person somehow begins to grieve -- including feelings of anger and despair -- that his or her feelings of emotional aliveness fully return. It turns out that, in the long run, Pollyana-ism is a threat to recovering a genuinely good quality of life.

So let's not exhort the people whose lives were forever changed at the finish line in Boston to be positive, to be heroic. We need to be open to their grieving and uncertainty. This is especially challenging for family members, perhaps because they are often struggling to suppress their own grief in an attempt to be supportive. Yet so long as the caregiver recognizes that she and the injured person are not feeling the same thing, shedding tears is likely to make everyone feel better.

Empathetic listening begins with recognizing that no one ever knows exactly how another person feels -- we teach medical students to avoid saying to patients: "I know how you feel." We should similarly encourage family and friends to encourage the person recovering from a traumatic loss to talk more about the experience: "Tell me what I'm missing."

In addition to listening, interviews with people demonstrate that we must improve the social conditions for including people with disabilities. A meaningful job and the feeling of belonging help return a sense of identity to the person.

Some of the runners injured April 15 will run again, some won't because they can't or because they choose not to. But they will find new purpose. What is right about Obama's words is that there are important connections between what is lost and what is found: the runners will not forget their marathon days; veterans will not forget the friends they've lost. History hurts, yet to deny that hurt is even worse. As individuals, too, our grief for what we've lost bestows value on new opportunities for living a good life.

Speaking of our collective grief over the death of 8-year-old Martin Richard, Obama movingly said: "our hearts are broken." What might we say in solidarity with the injured? "Our hearts are torn." There will be repair, but there will be scars of remembrance. Others can moralize about how scars might strengthen, our intent is therapeutic rather than moralistic. We need to make room for the injured to grieve even as we work together to ensure their full inclusion in American life.

Jodi Halpern, MD, is author of "From Detached Concern to Empathy: Humanizing Medical Practice." She is an associate professor of bioethics at UC Berkeley. Amy Slater, JD, is a lecturer at Goldman School of Public Policy at UC Berkeley.